The benefit of Yearly Mammogram in the Early Detection of Breast Cancer

In the last ten years, a concern that yearly mammograms for women under the age of 50 do more harm than good for most women has increased. As such, many researchers have engaged in studies to determine if the assertion is true or not. This paper reviews the latest research findings that suggest that mammography screening for women should start at the age of 50 years rather than below that age and that the frequency should be every two years instead of yearly until the age of 74.

Literature Review on Mammogram Screening

            In the 2018-paper “A review of Current American Cancer Society Guidelines and Current Issues in Cancer Screening” Smith and colleagues assert that mammograms are done at any age group whenever a lump is discovered. Nonetheless, mammography screening does not apply to all women. The researchers acknowledge that women at particularly high risk for breast cancer and those with sisters and mothers that have been diagnosed with the condition may have to begin mammograms between the ages of 40 and 50 or even earlier, though in rare cases (Smith et al., 2018). The bottom line is that while mammograms allow the detection of breast cancer in its earlier stages, they are not suitable in some cases.

In the article “Breast cancer screening with mammography plus ultrasonography or magnetic resonance imaging in women 50 years or younger at diagnosis and treated with breast conservation therapy”, the researchers examine mammograms use from the lens of numerous variables. According to the article, whether to start at age 50 or earlier hinges on several variables. For many women, who are not at particularly high risk of breast cancer, frequent mammograms should not be conducted before the age of 50 (Cho et al., 2017). However, to be careful, a woman can have a single mammogram at most around the age of 45 years.  Cho et al. (2017) suggest that the mammogram is normal, the woman can wait until she reaches 50 years for her second mammogram. Indeed, the National Center for Health Research and its Cancer Prevention and Treatment Fund has encouraged not more than one mammogram before the age of 50 years since 2007.  On the other hand, Oeffinger and his team of researchers state that women who have a higher risk of having breast cancer should not wait until they reach 50 to have frequent mammograms.  Those who are exposed to environmental hazards that could cause breast cancer due to environmental exposures are also advised to have frequent screening before 50 years. Notably, the assertion that the higher the age (50 years and above) the higher the frequency of mammograms is simply a guideline and not a rigid rule. Furthermore, mammogram screening applies to women irrespective of whether they are at risk of breast cancer or not. Additionally, if a woman discovers a lump on her breast, it important that she goes for a mammogram, irrespective of her age (Oeffinger et al., 2015).

Huzarski and colleagues examine the role that genetic mutation plays in screening. Women who have the BRCA genetic mutation, According to Huzarski et al. (2017), such women were in the past informed to start annual mammograms at between 25 and 30 years, because this mutation put them at greater risk of developing breast cancer. However, novel research has demonstrated that beginning annual mammograms before 35 years has no advantage and may even have adverse effects (Huzarski et al., 2017). Frequent mammograms expose women to radiation across their lifetime, which enhances their probability of developing breast cancer. Thus the technology that is meant to detect cancer in the early stages ends up causing the condition.

The study “Breast-cancer screening—viewpoint of the IARC Working Group” examines screening from the perspective of family history. The authors assert that many women who have female blood relatives who have had breast cancer at the age of 50 or above, or are at an enhanced risk of developing  the condition due to obesity or other variables may need to have frequent mammograms (every two years) beginning between the ages 40 and 50 (Lauby-Secretan et al, 2015). Lauby-Secretan et al. (2015) state that in the instance their relatives had breast cancer in their youthful years, women may need mammograms even before they reach 40 years. Unfortunately, women in their youth tend to have heavier breasts, which typically appear white on a mammogram. Since breast cancer also appears white, mammograms are not effective detecting breast cancer among younger women as well as those with heavy breasts (Lauby-Secretan et al., 2015). For such women, an MRI is likely to be more effective than a mammogram. Furthermore, MRIs are safer than mammograms. However, breast MRIs are costlier than mammograms. They cost about $2,000 while a mammogram costs $100 (Lauby-Secretan et al., 2015). The authors believe that there is no sufficient information to recommend or oppose MRIs. As such, medical insurance may not cover the expense. If a person wants the insurance agencies to pay for an MRI, he or she probably needs a physician to suggest it. Females with heavy breasts are at higher risk for developing cancer, particularly if they have relatives who had the condition in their younger years (Lauby-Secretan et al., 2015). Undoubtedly, they could perhaps benefit from frequent breast MRIs. However, studies lack definitive conclusions.

Certain risks may guide one’s decision regarding when to take mammography. An article written in 2015 by Dr. Moss and colleagues analyzed mammography for females at different ages and facing different risk variables. They assert that having mammography once every two years benefited health and were cost-effective for every woman between 40 and 70 years with dense breasts or with a family history of breast cancer as well as breast biopsy (Moss et al., 2015). Having mammography once every two years is advantageous for women between 50 and 69 years average breast density is average as well as for women between 60 and 79 years who have low breast density and have a family history of breast cancer (Moss et al., 2015). Yearly mammography is not cost effective for any age set. The authors conclude that each woman’s decision regarding mammography screening should be made on the basis of certain risk factors; history of breast biopsy, personal beliefs about the advantages and disadvantages of screening, breast density, age, and family history of breast cancer (Moss et al., 2015). The study reinforces the suggestions that women at increased risk of breast cancer can begin biennial (after every two years) screening after 50 years, and that women at increased risk of breast cancer should consider screening before reaching 50 years.

Looking at the frequency of screening for older women is important. The probability of developing breast cancer increases with age since the illness is much more prevalent after 50 years than below that age. On that account, from cost-effectiveness and a public health viewpoint, yearly screening mimeographs are most beneficial after 50 years of age. Mammograms before the age of 50 are less precise and are likely to lead to unwarranted biopsies and unnecessary anxiety. Klarenbach et al., (2017), do not recommend regular screening for women 75 years and above, since there is not sufficient evidence to infer whether or not the advantages outweigh the disadvantages. Nonetheless, the American Cancer Society suggests that annual screening should continue for older women whose health is robust enough that they are likely to live for more than ten years. Klarenbach et al. (2017), believe that this is a hard standard to enforce because many physicians do not want to inform their healthy elderly patients that they do not require mammography since they are not likely to live for more than ten years.

Overall, the review of the literature indicates that frequent mammography before 50 years is not necessarily beneficial for women. In fact, it could be harmful. Essentially, mammograms expose women to radiation, and this can increase the risk of them developing breast cancer. To that extent, postponing mammograms as long as possible without negative effects and decreasing their rate to every two years could help to save lives since it would significantly decrease exposure to radiation. Researchers believe that less regular mammograms involved entailing a decreased alarm rate, which means less unnecessary examinations, anxiety, and perhaps fewer unnecessary surgeries.

 

References

Cho, N., Han, W., Han, B. K., Bae, M. S., Ko, E. S., Nam, S. J., … & Song, B. J. (2017). Breast cancer screening with mammography plus ultrasonography or magnetic resonance imaging in women 50 years or younger at diagnosis and treated with breast conservation therapy. JAMA oncology3(11), 1495-1502.

Huzarski, T., Górecka-Szyld, B., Huzarska, J., Psut-Muszyńska, G., Wilk, G., Sibilski, R., … & Czudowska, D. (2017). Screening with magnetic resonance imaging, mammography, and ultrasound in women at average and intermediate risk of breast cancer. Hereditary cancer in clinical practice15(1), 4.

Klarenbach, S., Sims-Jones, N., Lewin, G., Singh, H., Thériault, G., Tonelli, M., … & Thombs, B. D. (2018). Recommendations on screening for breast cancer in women aged 40–74 years who are not at increased risk for breast cancer. CMAJ: Canadian Medical Association Journal190(49), E1441.

Lauby-Secretan, B., Scoccianti, C., Loomis, D., Benbrahim-Tallaa, L., Bouvard, V., Bianchini, F., & Straif, K. (2015). Breast-cancer screening—viewpoint of the IARC Working Group. New England journal of medicine372(24), 2353-2358.

Moss, S. M., Wale, C., Smith, R., Evans, A., Cuckle, H., & Duffy, S. W. (2015). Effect of mammographic screening from age 40 years on breast cancer mortality in the UK Age trial at 17 years’ follow-up: a randomized controlled trial. The lancet oncology16(9), 1123-1132.

Oeffinger, K. C., Fontham, E. T., Etzioni, R., Herzig, A., Michaelson, J. S., Shih, Y. C. T., … & Wolf, A. M. (2015). Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. Jama314(15), 1599-1614.

Smith, R. A., Andrews, K. S., Brooks, D., Fedewa, S. A., Manassaram‐Baptiste, D., Saslow, D., … & Wender, R. C. (2018). Cancer screening in the United States, 2018: a review of current American Cancer Society guidelines and current issues in cancer screening. CA: A Cancer Journal for Clinicians68(4), 297-316.